Where Americans Die: Home, Hospital or Nursing Home, 2004–2024

Disclaimer: General educational research only — not legal, medical or financial advice. Figures are from CDC National Center for Health Statistics death certificate files; what is possible for your family depends on your health, your state’s laws and the documents you have signed, so talk with your doctor and an estate planning attorney about your own plan.

Estate Planning Data & Research → Where Americans die

Every U.S. death certificate records where the person died: a hospital, their own home, a nursing home, a hospice facility or somewhere else. The CDC’s National Center for Health Statistics (NCHS) puts every certificate into a public file each year. We tallied all 3,072,666 deaths of U.S. residents in 2024, and every year back to 2004, from those files.

The shift over twenty years is large. In 2004, 46.1% of Americans died in a hospital and 24.5% died at home. In 2024, 34.8% died in a hospital and 34.3% died at home, so the two are now nearly tied. Among people 65 and older, home passed the hospital in 2022 and stayed ahead: 34.2% of older adults who died in 2024 died at home, compared with 31.8% in a hospital, 21.1% in a nursing home and 7.7% in a hospice facility.

Dying at home is what most people say they want, but it rarely happens by accident. It usually takes a diagnosis that is understood in time, a decision to stop aggressive treatment, a hospice team, a family that can provide care, and legal papers that tell doctors and relatives who is in charge. The same certificates also record marital status, and they show that most older Americans die without a living spouse — which shapes who will make those decisions and who will settle the estate.

Writing a will or setting up a trust is usually the step that pulls all of this together — the people you trust to decide, who inherits, and who handles things when you can’t. Our trust vs. will comparison explains which fits your family, what each costs, and how to get started.

Key findings

• Home deaths rose from 24.5% to 34.3%. In 2004, about 586,000 Americans died at home. In 2024, 1,054,545 did, about one death in three.
• Hospital deaths fell from 46.1% to 34.8%. That counts inpatients, emergency room and outpatient deaths, and people dead on arrival. Inpatient deaths alone fell from 37.6% to 28.8%; home has topped hospital inpatient deaths every year since 2016.
• For people 65 and older, home is now the most common place to die. Home passed all hospital settings in 2022 (34.1% vs. 33.7%). In 2024 it was 34.2% at home and 31.8% in a hospital.
• Nursing home deaths are falling but still common for the oldest. 17.1% of all 2024 deaths happened in a nursing home or long-term care facility, down from 22.1% in 2004. For people who died at 85 or older, it was 30.3% (41.7% in 2004).
• Hospice facilities now account for about 7%. 213,251 deaths (6.9%) happened in a hospice facility in 2024. Most hospice care is given at home, so this undercounts hospice use.
• Dementia deaths happen mostly in nursing homes. Of 224,550 deaths from Alzheimer’s disease and other dementias in 2024, 49.4% were in a nursing home, 26.9% at home and only 9.4% in a hospital.
• Cancer is the cause most likely to end at home. 45.7% of the 619,876 cancer deaths in 2024 happened at home, and 11.9% in a hospice facility.
• Most older Americans die without a spouse. Of 2,341,600 deaths at 65 or older in 2024, 38.4% were widowed, 16.9% divorced and 7.5% never married — 62.7% in all. Among women, only 22.7% were married when they died. The divorced share doubled from 8.5% in 2004.

Twenty years of change: where Americans died, 2004–2024

Source: Family Estate Guide tabulation of CDC/NCHS Multiple Cause of Death public-use files, 2004, 2009 and 2014–2024, U.S. residents only (deaths of foreign residents excluded). “All hospital settings” adds inpatient, emergency room or outpatient, and dead on arrival. Shares may not add to 100% because of rounding. The “hospice facility” box came with the 2003 revision of the death certificate, which states adopted gradually until 2017, so hospice facility shares before about 2014 are understated (those deaths were often coded “other”). In 2009, 71,909 certificates (3.0%) did not state a place of death.

Death certificates don’t record why the shift happened, but it lines up with a few long-running changes. Hospice, which Medicare has covered since the 1980s, became a routine part of end-of-life care, and most hospice patients are cared for where they live. More people now die of slow illnesses such as dementia, cancer and heart failure, where there is time to decide where care should end. And more families now choose to care for a dying parent or spouse at home rather than in a facility.

The pandemic years were the exception. Most COVID-19 deaths happened in hospitals (79.9% in 2021, counting emergency rooms), so the hospital share jumped to 39.5% in 2021, and the nursing home share dropped to 14.1%. By 2024 the shares were back on the pre-pandemic trend, with home deaths about 2.6 points higher than in 2019.

Age 65 and older: home is now first

Source: CDC/NCHS Multiple Cause of Death public-use files, U.S. residents age 65 and older. Every year from 2014 through 2024 is in the CSV download.

Older adults account for 76% of all deaths (2,341,600 of 3,072,666 in 2024), so their pattern drives the national numbers. For them, the realistic choices at the end of life are home, a nursing home or a hospital, and only about one in three dies in a hospital now.

By age: the oldest die in nursing homes, the youngest in hospitals

Source: CDC/NCHS Multiple Cause of Death public-use file, 2024 and 2004, U.S. residents. Deaths with age not stated (57 in 2024) are excluded from this table but included in the totals above. “Other” for people under 45 is mostly deaths from accidents, overdoses and violence outside a home or medical setting.

Home deaths rose in every age group. The biggest change was among people who died at 85 or older: 17.9% died at home in 2004, compared with 32.3% in 2024, while their nursing home share fell from 41.7% to 30.3%. More very old people now spend their last days at home, usually with a spouse or an adult child as caregiver. That is the group most likely to need someone else to manage money and sign medical decisions in the last months, which is why the paperwork matters most for them.

By cause of death: dementia, cancer and heart disease

Source: CDC/NCHS Multiple Cause of Death public-use files, 2024 and 2004, underlying cause of death. ICD-10 groups: dementia F01–F03 and G30; cancer C00–C97; heart disease I00–I09, I11, I13 and I20–I51; stroke I60–I69; chronic lower respiratory disease J40–J47; COVID-19 U07.1; external causes V01–Y89. Rows add to all 3,072,666 deaths.

Dementia stands out. Half of dementia deaths happen in a nursing home, and almost none in a hospital. A person with dementia also loses the ability to sign legal papers long before death. Once that happens, a power of attorney, health care proxy, will or trust can no longer be signed, and the family may have to go to court for a guardianship or conservatorship. Our incapacity gap page shows how many older adults already live with serious cognitive difficulty.

Cancer is the opposite case. It is the cause most likely to end at home (45.7%) or in a hospice facility (11.9%), because the course is often predictable enough for a hospice referral. Families dealing with a cancer diagnosis usually have months, not days, to put documents in order. Heart disease deaths have moved home the fastest, from 24.7% in 2004 to 39.3% in 2024. Heart disease also has the highest share of emergency room or outpatient deaths among the diseases shown (9.9%), because many heart deaths are sudden.

Marital status at death: most older Americans die without a spouse

Source: CDC/NCHS Multiple Cause of Death public-use files, 2024 and 2004, U.S. residents age 65 and older. Women and men columns are shares of each sex; the last row shows the number of deaths. Marital status is what the informant (usually a family member) reported on the death certificate.

The share of older Americans who were unmarried when they died has barely moved, 62.9% in 2004 and 62.7% in 2024. What changed is why. Widowhood fell from 48.9% to 38.4% as men live longer, while the divorced share doubled from 8.5% to 16.9% and the never-married share rose from 5.5% to 7.5%. For women, the picture is starkest: 77% of women who died at 65 or older in 2024 had no spouse, compared with 48% of men.

Marital status also tracks where people die. Married people 65 and older were the most likely to die at home (38.9%) and the least likely to die in a nursing home (13.3%), because a spouse is often the caregiver. Widowed people were the most likely to die in a nursing home (27.7%).

Source: CDC/NCHS Multiple Cause of Death public-use file, 2024, U.S. residents age 65 and older.

What this means for your plan

Where someone dies, and who is standing next to them, decides a lot about what the family has to do. The data point to a few practical steps.

Write down where you want to be, and who decides. A home death almost always follows a decision to stop treatment aimed at cure. That decision is easier when you have a health care proxy (also called a health care power of attorney) naming one person to speak for you, and an advance directive or living will saying what you want. Federal law requires hospitals, nursing homes, home health agencies and hospices that take Medicare to give adult patients written information about their right under state law to make medical decisions and write an advance directive, and to note in the medical record whether they have one. It doesn’t require anyone to have one, and the hospital can’t write it for you. See end-of-life wishes by state for hospice use and state law, and advance care planning in Medicare by state for how often doctors bill for these conversations.

Plan for the money side of caring at home. Being cared for at home for months often means a family member pays bills, talks to banks and handles insurance. A durable financial power of attorney lets that person act without a court order. Without one, the bank may refuse even a spouse or child. Our power of attorney abuse watch explains how to pick an agent and add safeguards.

If dementia runs in your family, sign early. Half of dementia deaths happen in nursing homes, and long stays there are often paid for by Medicaid, which can later seek repayment from the estate. You need legal capacity to sign a will, trust or power of attorney, and dementia can take it away years before death. See Medicaid estate recovery by state and our page on nursing home capacity by state.

Assume there may be no spouse to step in. Six in ten older Americans die widowed, divorced or never married, and three in four older women do. When there is no spouse, the people who make medical decisions and settle the estate are usually adult children, siblings, nieces and nephews or a professional. If you don’t name them, state law ranks your relatives for you. Our intestacy gap page shows how that default works, and who will be your executor covers the choice of someone to settle the estate.

Divorced? Check every beneficiary form. The divorced share of older deaths doubled in twenty years. Many states automatically cancel gifts to an ex-spouse in a will after a divorce, and some extend that to life insurance and other beneficiary designations. But employer retirement plans and group life insurance governed by the federal ERISA law generally pay whoever is named on the plan’s form, even an ex-spouse (the U.S. Supreme Court so held in Egelhoff v. Egelhoff, 2001). Update the forms, not just the will. Our page on money that skips the will explains why.

Make sure the right people can get medical information. Under the federal HIPAA privacy rule, a person with legal authority to make health care decisions for you is treated as your “personal representative” for your medical records. A health care proxy gives a relative that standing; being next of kin alone may not.

Methodology

We downloaded the NCHS Multiple Cause of Death public-use data files for 2004, 2009 and every year from 2014 through 2024 from the CDC’s public file server. Each file has one record per death certificate filed in the United States. We kept records for U.S. residents and dropped the small number of deaths of foreign residents (9,798 in 2024), which matches how NCHS reports national deaths. Our 2024 totals match the CDC’s official figures: 3,072,666 deaths, including 683,491 from heart disease, 619,876 from cancer, 166,852 from stroke and 145,643 from chronic lower respiratory disease.

We read four fields from each record: place of death (file position 83), marital status (84), age group (Age Recode 12, positions 79–80) and the underlying cause of death code (ICD-10, positions 146–149). Sex (position 69) is used for the women and men columns. Place of death has eight codes: hospital inpatient, hospital outpatient or emergency room, dead on arrival, decedent’s home, hospice facility, nursing home or long-term care, other, and unknown. We grouped the first three as “all hospital settings.”

Limitations:

• The public files have had no state or county detail since 2005, so these are national figures only. CDC does not publish place of death by state in its open files.
• Place of death is the physical location, not the type of care. Someone receiving hospice care at home is counted as a home death; a hospital death may follow weeks of hospice elsewhere.
• “Home” means the decedent’s own residence. Assisted living facilities are not a separate category and may be coded as home, nursing home or other depending on the state and the facility.
• The hospice facility category was phased in with the 2003 death certificate revision; states finished the transition in 2017. Compare hospice facility shares only from about 2014 on.
• Marital status is reported by an informant, usually a family member, and is sometimes wrong or missing (0.8% not stated for deaths at 65+ in 2024).
• These are counts of deaths, not people’s wishes. A home death is not always a planned or peaceful one; it also includes sudden deaths from heart attacks, falls and overdoses.

Frequently asked questions

What percentage of people die at home in the United States?

In 2024, 34.3% of U.S. residents who died, 1,054,545 people, died at home. That is up from 24.5% in 2004. Among people 65 and older, 34.2% died at home, more than in any other place.

Do more people die at home or in the hospital now?

For all ages combined it is nearly a tie: 34.8% in a hospital (including emergency rooms) and 34.3% at home in 2024. Home has outnumbered hospital inpatient deaths every year since 2016. For people 65 and older, home has been ahead of all hospital settings since 2022.

How many people die in nursing homes?

In 2024, 524,350 deaths (17.1%) happened in a nursing home or long-term care facility. The share is much higher for the oldest people (30.3% of deaths at 85 or older) and for people with dementia (49.4%).

Does dying at home mean the person had hospice?

Not necessarily. The death certificate records the place, not the care. Most hospice patients are cared for at home, so many home deaths are hospice deaths, but home deaths also include sudden deaths. Medicare covers hospice when a doctor certifies a life expectancy of six months or less if the illness runs its normal course.

What documents do I need if I want to die at home?

Most people need a health care proxy (health care power of attorney) naming who decides for them, an advance directive or living will stating their wishes, and often a POLST or similar medical order signed by a doctor if they are seriously ill. A durable financial power of attorney lets a family member handle bills during a long illness. A will or trust then covers what happens after death. The forms and witness rules differ by state.

Who makes medical decisions if I don’t have a health care proxy?

Most states have a default “surrogate” law that ranks relatives, usually a spouse first, then adult children, parents and siblings. Because 62.7% of Americans who die at 65 or older are not married, that default often falls on adult children, who must agree with each other. If no one qualifies or the family disagrees, a court may have to appoint a guardian.

Does it matter for my estate where I die?

Not legally: a will or trust works the same wherever death happens. But the place of death often reflects months of care before it, and that care is where a power of attorney, Medicaid planning and beneficiary choices make the biggest difference. Nursing home stays paid by Medicaid can lead to an estate recovery claim after death.

Sources

Data

• CDC National Center for Health Statistics, Multiple Cause of Death public-use data files, 2004, 2009 and 2014–2024 (one record per U.S. death certificate): https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/DVS/mortality/
• NCHS, 2024 Mortality Multiple Cause-of-Death Public Use Record documentation (field locations for place of death, marital status, age, sex, underlying cause and resident status): https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/mortality/2024-Mortality-Public-Use-File-Documentation.pdf
• NCHS record layouts for earlier years (2004, 2009, 2014): https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/mortality/
• CDC FastStats, Deaths and Mortality (official 2024 U.S. total and leading-cause counts used to check our tabulation): https://www.cdc.gov/nchs/fastats/deaths.htm

Law and guidance

• 42 U.S.C. 1395cc(f), Medicare provider requirements on advance directives (Patient Self-Determination Act): https://www.law.cornell.edu/uscode/text/42/1395cc
• 42 CFR 418.3 (definition of terminally ill for the Medicare hospice benefit) and 418.22 (certification of terminal illness): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418
• 45 CFR 164.502(g), HIPAA privacy rule, personal representatives: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.502
• 42 U.S.C. 1396p(b), Medicaid estate recovery: https://www.law.cornell.edu/uscode/text/42/1396p
• Egelhoff v. Egelhoff, 532 U.S. 141 (2001): https://www.law.cornell.edu/supct/html/99-1529.ZO.html

Cite this data

Published November 10, 2026 by Family Estate Guide. Figures are Family Estate Guide tabulations of every U.S. resident death certificate in the NCHS Multiple Cause of Death public-use files; the 2024 file is the latest NCHS has released, and its U.S. total matches the CDC’s official count of 3,072,666 deaths. Editorial standards.